The psychology of crises, emergencies and catastrophes is an area of recent development within the context of the scientific discipline of psychology. However, Spain has experienced rapid growth in this field since the late 1990s due to the demand for psychological intervention in crisis situations. The common symptoms experienced by victims and the need to provide psychological support in both everyday emergencies and major catastrophes have historically evolved. It is important to regulate this discipline to guarantee the training of professionals and the integration of this discipline into the public care system 1.
In our national context, the 1996 Biescas flood and the provision of psychological assistance services near ground zero is usually considered the start of this contemporary field and the provision of psychological assistance in the face of a critical incident.
Subsequent events related to massive terrorist attacks (September 11, 2001, in the United States or March 11, 2004, in Spain) highlighted the need for the development of procedures and protocols not only for psychological assistance to direct and indirect victims but also for the management and organization of psychological assistance devices on a large scale in the face of massive critical incidents.
More recent events, such as the emergence of severe acute respiratory system coronavirus 2 (SARS-CoV-2), leading to the coronavirus disease 2019 (COVID-19) pandemic, declared as such by the World Health Organization on March 11, 2020, led to the urgent need for a new psychological intervention model to address the crisis and provide direct support to affected people. The study of Cervellione 2 aimed to evaluate the symptoms and reactions of the population to the event using data collected from the triage cards used by SIPEM SoS Emilia Romagna (Italy) with the goal of describing the clinical symptoms and defining the criteria of emergency psychology. A total of 40.9% of respondents requested psychological support for the management of anxiety symptoms, a need that was also reported by 55% of the respondents who reported previous psychological problems. At the same time, in 2022, Panzeni 3 developed the Perceived Psychosocial Support Scale (PSSS) to assess perceived psychological and social support in clinical and emergency settings. The PSSS was administered to a clinical sample during the early period of the COVID-19 pandemic, and good psychometric properties were found. The results indicated that fewer sessions and more emotional symptoms were associated with lower scores on the PSSS, suggesting that this scale may be useful for individualizing treatments and allocating resources in clinical and emergency settings.
While the occurrence of railway or aeronautical accidents led to the development of large-scale psychological assistance procedures in situ (i.e., close to ground zero) or in family care centres, it has not been until recent years that these needs have been included in the specific legislation regarding the responses that the airline or railway companies must provide in Spain. However, in Spain and throughout the world, large organizations have created good practice guidelines that must be followed for correct performance of psychological work, including "Ethical Principles of Psychologists and Codes of Conduct” by the American Psychological Association 4, “Entry-to-Practice Competency Profile for Counselling Therapists” by the Federation of Associations of Counselling Therapists in British Columbia 5 and the “Code of Ethics of the Psychologist” by the General Council of Psychology of Spain 6.
After Hurricane Katrina in 2005, the speed at which emergency devices were activated was key, and the authors recommended the implementation of a series of unified tools for the correct organization of responses to these situations 7. For this reason, organizations such as the Pan American Health Organisation promoted the development and implementation of articles, manuals and guidelines on hospital triage systems 8. This promotion was also supported by Ursano (2003), who pointed out the need to develop care strategies for mental health at both the individual level and the community level 9. Importantly, Ursano also mentions in his book that it is important for emergency psychologists to consider that the most severe psychiatric consequences are those due to terrorist acts and torture.
The 20-item Self-Report Questionnaire (SRQ-20) was used to evaluate distress in Vietnamese adults before and after Typhoon Xangsane 10. Variations in mental health symptoms were observed, and sex and age played important roles, as women and older people experienced greater distress. The association of factors such as evacuation, personal injury, and fear during the event differed with distress levels, which were dependent on the age and sex of the participants.
However, individuals can also find themselves in micro situations, such as domestic violence. In 1995, 11 the challenges faced by medical and mental health professionals in dealing with cases of family violence, especially in primary care settings, were highlighted. The characteristics of both physicians and patients that make the detection of domestic violence difficult were examined, and the role of psychologists in these settings in terms of facilitating the detection and treatment of violence was highlighted. It was concluded that efforts should include educating clinicians through collaboration and providing on-site resources for information and consultation.
The symptoms that the relatives of the victims of a crisis situation may present can vary depending on multiple factors, such as the age of the person, the type of crisis situation, the medical and psychological history of the person and the person’s existing psychosocial situation. The expected psychological symptoms are mainly anxious or depressive characteristics, although other types of psychological symptoms may appear. In this type of situation, it is essential that mental health professionals be able to identify the psychological, physiological, behavioural and community responses that these types of crisis situations, which are increasingly part of daily life, produce. A prior competence profile must be obtained, and emergency psychologists must have training in obtaining these profiles 12. According to the scientific literature, when faced with a critical incident, people have a greater tendency to develop psychological symptoms than physical symptoms, which means that mental health resources may be overwhelmed; therefore, it is essential to train mental health professionals in interventions during crises, which will, in turn, lead to more effective use of emergency services 13.
In 2005, the results of an investigation on the evaluation of competencies necessary for professional practice in psychology were presented. The importance of evaluation to improve both the initial training and the continuous development of psychologists was highlighted 14. Additionally, among the competencies that mental health professionals who act after critical incidents should have, it is worth highlighting the ability to assess the situation and the associated symptoms and the ability to prioritize, as it is essential to have good tools of triage that allow working with common criteria. It is also convenient to develop liaison psychiatric assistance with other postaccident health services 15.
There are three competencies that stand out in the competency profiles of crisis and emergency workers. On the one hand, resilience can be defined as the ability to recover or successfully cope with adverse circumstances. Resilience promotes positive adaptation to adverse situations and is associated with good psychosocial adjustment and good mental health 16. In health personnel, such as nurses, this concept is very relevant and is linked to other factors, such as the balance between personal and work life or the ability to cope 17. Resilience not only affects self-care but also patient care and is especially relevant in contexts in which there is continuous exposure to human suffering and/or work conditions that can be considered stressful 18.
Empathy can contribute to resilience by providing meaningful connections with others, emotional support, and a deeper understanding of shared experiences during difficult times, such as those that occur after critical incidents 19.
On the other hand, emotional intelligence can be defined as the ability to know one's own emotions and be aware of other emotions 20. Emotional intelligence allows an individual to rationalize their emotions and involves the processing of emotional information 21. This competence is very relevant for crisis interventions since it allows correct processing of information and the ability to correctly identify, understand and manage one’s own emotions and those of third parties 22. Emotional intelligence comprises three components 23: emotional attention, i.e., the identification of emotions; emotional clarity, i.e., the understanding of emotions; and emotional repair, i.e., emotional recovery from critical events (e.g., focusing on positive aspects rather than negative ones). Emotional intelligence is related to psychological well-being, mental health, decreased anxiety-depression symptoms 24 and good psychological adjustment 25. Psychologists who are able to understand and control their own emotions can also understand and help manage their patients' emotions (as long as it is done compassionately and not experimentally). Psychologists’ ability to manage their own feelings allows them to provide more effective and understanding support, thus creating a more beneficial therapeutic environment for their patients. This capacity allows the psychologist to carry out a positive restructuring of their emotions, reducing their level of discomfort 26. Emotional intelligence could be related to health and disease processes and could be a protective factor. A positive relationship was also found between emotional intelligence and psychological well-being, empathy and self-esteem 27. Strong emotional intelligence is closely linked to good mental health, while low emotional intelligence is related to mental health problems 28.
The objective of this study was to develop the Crisis and Emergency Intervention Skills Scale (CEISS) and to analyse its psychometric properties and the relationship of the CEISS score with the most relevant job competencies for health work in emergencies. Based on the bibliographic review carried out, it is essential to have a standardized measuring instrument that allows evaluating whether the professional competencies possessed by a person are adequate to carry out this type of work. An instrument with these very specific characteristics has yet to be developed.